SRT-100放射治疗儿童增生性瘢痕的临床疗效初探
蒙礼娟, 麻艺群, 王璐, 张梦思, 范鑫, 许水淋, 杨丽红, 朱辉, 付晋凤
昆明市儿童医院　昆明医科大学附属儿童医院烧（创）伤整形外科
云南省教育厅科学研究基金项目(2023J0294)
通信作者: 付晋凤

目的
    观察SRT-100皮肤浅层X线放射治疗系统治疗儿童增生性瘢痕的临床疗效。

方法
    回顾性分析昆明市儿童医院烧(创)伤整形外科2020年9月至2023年5月治疗的27例患儿病历资料，共42处增生性瘢痕。根据治疗方法分为常规治疗组21例，行常规抗瘢痕治疗(外用抗瘢痕药物、压力套)；联合放射治疗组21例，行常规抗瘢痕治疗(外用抗瘢痕药物、压力套)联合SRT-100皮肤浅层X线放射治疗。增生性瘢痕于创面愈合后1～3个月开始放射治疗，每周1次，4次后间隔1～2个月视瘢痕增生情况确定是否继续治疗，一个疗程4～8次。管电压50～70 kV，单次剂量350～400 cGy，总剂量不超过30 Gy，照射时间30～60 s/次。照射时瘢痕周围正常皮肤用铅片保护，腺体部位禁止照射。2组在治疗前(瘢痕病程2个月内)和治疗后(瘢痕病程6个月，常规治疗组为接受常规治疗的第4～5个月，联合放射治疗组为接受4次放射后3～4个月或者8次放射后1～2个月)分别采用温哥华瘢痕量表(VSS)进行评分，记录疗效、患儿家属满意度。治疗后随访6～24个月，观察不良反应。数据比较采用独立样本t检验、χ2检验、秩和检验。
结果
    常规治疗组治疗前后VSS评分为(11.9±1.2)分和(9.7±1.7)分，差异有统计学意义(t＝10.869，P<0.001)；其中显效0例，有效18例，无效3例，有效率为85.7%，显效率为0；患儿家属非常满意0例，比较满意2例，一般满意16例，不满意3例，总体满意率85.7%；不良反应为色素沉着和皮肤干燥，无瘢痕破溃及皮炎发生。联合放射治疗组治疗前后VSS评分为(11.2±1.2)分和(4.7±0.8)分，差异有统计学意义(t＝24.726，P<0.001)，且联合放射治疗组的降低幅度明显大于常规治疗组(t＝12.805，P<0.001)；其中显效14例，有效7例，无效0例，有效率为100%，显效率为66.7%；患儿家属非常满意14例，比较满意7例，一般满意0例，不满意0例，总体满意率100%；4例患儿出现放射性皮炎，表皮破溃、湿疹，予常规换药治疗后愈合，余不良反应为一过性色素沉着、皮肤干燥。联合放射治疗组的疗效(Z＝－4.568，P<0.001)和患儿家属满意度(Z＝－5.668，P<0.001)均优于常规治疗组。
结论
SRT-100皮肤浅层X线放射治疗系统可有效抑制瘢痕增生，患儿家属满意度较高，不良反应发生率较低，且其方便、无痛、安全，是儿童增生性瘢痕预防和治疗的又一选择。

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To investigate the clinical effects of X-ray radiation on superficial layer of skin with SRT-100 equipment in the treatment of hypertrophic scars in children.

Data of 27 children with 42 hypertrophic scars treated in Kunming Children′s Hospital from September 2020 to May 2023 were analyzed retrospectively and divided into the routine treatment group (n=21) and combination with radiotherapy group (n=21). The children in the routine treatment group only received conventional anti-scar treatment (external use of ant-scar drugs and pressure therapy). The children in the combination with radiotherapy group received X-ray radiation on superficial layer of skin with SRT-100 equipment on the basis of conventional anti-scar treatment. Hypertrophic scars started to be irradiated 1-3 months after wound healing, once a week for 4 times and later continuation or not depending on visual scar hyperplasia conditions after an interval of 1-2 months, and 4-8 times as a course of treatment. The parameters were set as 50-70 kV, single dose of 350-400 cGy, the total dose of no more than 30 Gy and irradiation time of 30-60 seconds once. Protecting normal skin around scars with lead sheets during irradiation and the glandular sites were prohibited from irradiation. Before treatment (scar progression within 2 months) and after treatment (scar progression for 6 months: the routine treatment group received routine treatment for 4-5 months, while the combined with radiotherapy group received four doses of radiation and then three or four months later, or one to two months after eight doses of radiation), the Vancouver scare scale (VSS) was used to score, and the effectiveness of treatment and the satisfaction of children′s family were recorded. All children were followed up for 6-24 months, during which the adverse reactions were observed. The data were comparied by t-test, chi-square test and wilcoxon test between the two groups.

The VSS scores were (11.9±1.2) points and (9.7±1.7) points before and after the routine treatment, and the difference was statistically significant (t=10.869, P<0.001); none was judged as markedly effective, 18 cases were judged as effective, and 3 cases did not show any effect, thus the effective rate and the significant effective rate were 85.7% and 0; none of children′s families got very satisfied, 2 children′s families got relatively satisfied, 16 children′s families got generally satisfied, and 3 children′s families got dissatisfied, and the overall satisfaction was 85.7% in the routine treatment group, and in which the side effects such as pigmentation and dry skin were found without any scar rupture and dermatitis. The VSS scores were (11.2±1.2) points and (4.7±0.8) points before and after the treatment in the combination with radiotherapy group and the difference was statistically significant (t=24.726, P<0.001). The reduction of VSS scores was significantly greater in the combination with radiotherapy group than in the routine treatment group (t=12.805, P<0.001). Fourteen cases were judged as markedly effective, 7 cases were judged as effective, and no ineffective case was found, with the effective rate of 100% and the significant effect rate of 66.7%; 14 children′s families got very satisfied, 7 children′s families got relatively satisfied, and no generally satisfied or dissatisfied cases were found, with the overall satisfaction of 100% in the combination with radiotherapy group. There were 4 children who were found radiation dermatitis, epidermal ulceration and eczema, healed after routine dressing change, and the other side effects were transient pigmentation and dry skin in the combination with radiotherapy group. The effective rate (Z=-4.568, P<0.001) and the overall satisfaction (Z=-5.668, P<0.001) were higher in the combination with radiotherapy group than in the routine treatment group.

X-ray radiation on the superficial layer of skin with SRT-100 equipment can effectively inhibit scar hyperplasia with a high satisfaction of children′s families and a low incidence of adverse reaction, thus it is an alternative therapy for the prevention and treatment of hypertrophic scars in children with advantages of convenience, no pain, safety and obvious curative effect.